L E T T E R T O H O U S E H O L D

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Free and Reduced Price School Meals Application Letter to Households

L E T T E R T O H O U S E H O L D

Dear Parent/Guardian: School Year 2014 – 2015

* * * * * * * * * * * * * * * NEW THIS SCHOOL YEAR ! ! ! * * * * * * * * * * * * * * * This school year you will have several options available for completing a Free & Reduced Price Meal Application. We now offer an online application thru your Parent Portal account. This will speed up the application process. When you log into Parent Portal the application is on the left side under the

“Application/Forms” tab. If you do not have access to Parent Portal, you may request access thru the website: www.norman.k12.ok.us or by contacting your child’s school directly. We are also enclosing an application with this letter or you may pick up an application at your child’s school.

Children need healthy meals to learn. Norman Public Schools offers healthy meals every school day. Breakfast costs $0.90/$0.95; lunch costs $2.20/$2.35. Your children may qualify for free meals or for reduced price meals. Reduced price is $0.30 for breakfast and $0.40 for lunch. Below are some common questions and answers to aid in the process of determining your child’s eligibility.

1. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to:

any NPS kitchen staff or mail to Child Nutrition 111 N Berry Road, Norman, OK 73069.

2. WHO CAN GET FREE MEALS? All children in households receiving benefits from Supplemental Nutritional Assistance Program (SNAP), Food Distribution Program on Indian Reservations (FDPIR), or Temporary Assistance for Needy Families (TANF) can get free meals regardless of your income. Also, your children can get free meals if your household’s gross income is within the free limits on the Federal Income Eligibility Guidelines.

If you have received a NOTICE OF DIRECT CERTIFICATION for the current school year for free meals, do not complete the application.But do let the school know if any children in your household are not listed on the Notice of Direct Certification letter you received.

3. CAN FOSTER CHILDREN GET FREE MEALS? Yes, foster children that are under the legal responsibility of a foster care agency or court, are eligible for free meals.

4. CAN HOMELESS, RUNAWAY, HEAD START AND MIGRANT CHILDREN GET FREE MEALS? Yes, children who meet the definition of homeless, runaway, or migrant are eligible for free meals. If you believe children in your household meet these descriptions and haven’t been told your children will get free meals, please call Rex Wall at 405-447-6577 to see if they qualify.

5. WHO CAN GET REDUCED PRICE MEALS? Your children can get reduced price meals if your household income is within the reduced price limits on the Federal Eligibility Income Chart, shown on this application.

6. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE APPROVED FOR FREE MEALS? No, but please read the letter you got carefully and follow the instructions. Call Child Nutrition at 405-366-5908 if you have questions.

7. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child’s application is only good for that school year and for the first few days of this school year. You must send in a new application unless the school told you that your child is eligible for the new school year.

8. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please send in an application.

9. WILL THE INFORMATION I GIVE BE CHECKED? Yes and we may also ask you to send written proof.

10. IF I DON’T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example, children with a parent or guardian who becomes unemployed may become eligible for free or reduced price meals if the household income drops below the income limit.

11. WHAT IF I DISAGREE WITH THE SCHOOL’S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also may ask for a hearing to have the decision reviewed.

12. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You or your children do not have to be U.S. citizens to qualify for free or reduced price meals.

13. WHO SHOULD I INCLUDE AS MEMBERS OF MY HOUSEHOLD? You must include all people living in your household, related or not (such as grandparents, other relatives, or friends) who share income and expenses. You must include yourself and all children living with you. If you live with other people who are economically independent (for example, people who you do not support, who do not share income with you or your children, and who pay a pro-rated share of expenses), do not include them.

14. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income.

15. WE ARE IN THE MILITARY. DO WE INCLUDE OUR HOUSING ALLOWANCE AS INCOME? If you get an off-base housing allowance, it must be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income.

16. MY SPOUSE IS DEPLOYED TO A COMBAT ZONE. IS HER COMBAT PAY COUNTED AS INCOME? No, if the combat pay is received in addition to her basic pay because of her deployment and it wasn’t received before she was deployed, combat pay is not counted as income. Contact your child’s school for more information.

17. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for (SNAP) or other assistance benefits, contact the Cleveland County Department of Human Services at 405-521-3076.

If you have other questions or need help, call 405-366-5908.

Sincerely, Child Nutrition Norman Public Schools

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Free and Reduced Price School Meals Application Application

Page 1 of 3 SY 2014-2015

I N S T R U C T I O N S F O R A P P L Y I N G

A HOUSEHOLD MEMBER IS ANY CHILD OR ADULT LIVING WITH YOU.

IF YOUR HOUSEHOLD RECEIVES BENEFITS FROM SNAP, TANF, OR FDPIR, FOLLOW THESE INSTRUCTIONS:

Part 1: List only household members and the name of each child’s school (if known).

Part 2: List the case number for any household member (including adults) receiving SNAP, TANF, or FDPIR benefits. One case number per household will qualify all enrolled students within the household.

Part 3: Skip this part.

Part 4: Sign the form. The last four digits of a Social Security Number are not necessary.

Part 5: Answer this question if you choose.

Turn the form in to your child’s school.

IF NO ONE IN YOUR HOUSEHOLD GETS SNAP, TANF, OR FDPIR BENEFITS AND IF ANY CHILD IN YOUR HOUSEHOLD IS HOMELESS, A MIGRANT OR RUNAWAY, OR IN HEAD START FOLLOW THESE INSTRUCTIONS:

Part 1: List all household members and the name of each child’s school (if known). If any child you are applying for is homeless, migrant, in Head Start or a runaway check the appropriate box and call Rex Wall at 405-447-6577.

Part 3: Complete only if a child in your household isn’t eligible under Part 1. See instructions for All Other Households.

Part 4: Sign the form. The last four digits of a Social Security Number are not necessary if you didn’t need to fill in Part 3.

IF YOU ARE APPLYING FOR A FOSTER CHILD, FOLLOW THESE INSTRUCTIONS:

If all children in the household are foster children:

Part 1: List all foster children and the school name for each child. Check the box indicating the child is a foster child.

Part 4: Sign the form. The last four digits of a Social Security Number are not necessary.

If some of the children in the household are foster children:

Part 1: List all household members and the name of each child’s school (if known). For any person, including children, with no income, you must check the “No Income” box. Check the box for each foster child. If any child you are applying for is homeless, migrant, in Head Start or a runaway check the appropriate box and if you have questions call Rex Wall at 405-447-6577.

Part 3: Complete only if a child in your household isn’t eligible under Part 1. See instructions for All Other Households.

Part 4: Adult household member must sign the form and list the last four digits of their Social Security Number (or mark the box if s/he doesn’t have one).

ALL OTHER HOUSEHOLDS, INCLUDING WIC HOUSEHOLDS, FOLLOW THESE INSTRUCTIONS:

Part 1: List all household members and the name of each child’s school (if known). For any person, including children, with no income, you must check the “No Income” box. If any child you are applying for is homeless, migrant, Head Start, a foster child or a runaway check the appropriate box and call Rex Wall at 405-447-6577.

Part 3: Follow these instructions to report total household income from this month or last month.

 Section 1–Name: List all household members with income.

 Section 2 –

o Gross Income and How Often It Was Received: For each household member listed in section 1, list each type of income received for the month. You must tell us how often the money is received—weekly, every other week, twice a month or monthly.

o Earnings: Be sure to list the gross income, not the take-home pay. Gross income is the amount earned before taxes and other deductions.

You should be able to find it on your pay stub or your boss can tell you.

o Income received from welfare, child support, and alimony: List the amount each person received.

o Income received from retirement benefits, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits: List the amount each person received.

o All Other Income: List Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income. Do not include benefits from WIC, Federal education and foster payments received by the family from the placing agency. For ONLY the self-employed, under Earnings from Work, report income after expenses. This is for your business, farm, or rental property. If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income.

Part 4: Adult household member must sign the form and list the last four digits of their Social Security Number (or mark the box if s/he doesn’t have one).

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NORMAN PUBLIC SCHOOLS

2014-2015 FREE & REDUCED PRICE SCHOOL MEALS APPLICATION

PART 1. ALL HOUSEHOLD MEMBERS Names of all household

members

(First, Middle Initial, Last)

Name of each child’s school /or indicate “NA” if child is not in school

Place a check in the box below if child is a foster, homeless, migrant, runaway, or Head Start child. If each child attending school is a foster, homeless, runaway, migrant or in Head Start, skip to part 4 to sign this form.

Place a check in the box if NO income Foster Homeless Migrant Runaway Head Start

                                   

Part 2. BENEFITS

IF ANY MEMBER OF YOUR HOUSEHOLD RECEIVES SANP, FDPIR, OR TANF, PROVIDE THE NAME AND CASE NUMBER FOR THE PERSON WHO RECEIVES BENEFITS AND SKIP TO PART 4.

IF NO ONE RECEIVES THESE BENEFITS, SKIP TO PART 3.

NAME:____________________________________ PROGRAM NAME (SNAP; TANF; OR FDPIR ONLY) _______________________________

CASE NUMBER: (NOT EBT CARD NUMBER)_____________________________________________

PART 3. TOTAL HOUSEHOLD GROSS INCOME (BEFORE DEDUCTIONS). List all income on the same line as the person who receives it. Check the box for how often it is received. RECORD EACH INCOME ONLY ONCE.

1.N^AME

(LIST ONLY HOUSEHOLD MEMBERS WITH INCOME)

2. GROSS INCOME AND HOW OFTEN IT WAS RECEIVED Earnings

from work before deductions.

Weekly Every 2 Weeks Twice Monthly Monthly

Welfare, child support, alimony

Social Security, SSI, VA, retirement

benefits

All other income (such as Unemployment)

benefits

(Example) Jane Smith $200 X $150 X $0 $0

$ $ $ $

PART 4. SIGNATURE AND LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER (ADULT MUST SIGN)

An adult household member must sign the application. If Part 3 is completed, the adult signing the form also must list the last four digits of his or her Social Security Number or mark the “I do not have a Social Security Number” box. (See Statement on the back of this page.)

I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will get Federal funds based on the information I give. I understand that school officials may verify (check) the information. I understand that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted. I understand my child’s eligibility status may be shared as allowed by law.

Signature: ________________________________________________________________ Printed name: ________________________________ Date: ______________________

Address:___________________________________________________________________ Phone Number: _______________________________ Email:_____________________

City: _______________________________________________________________________ State: ____________________________ Zip Code: ______________________________

Last four digits of Social Security Number: * * * - * * - ___ ___ ___ ___  I do not have a Social Security Number PART 5. CHILDREN’S ETHNIC AND RACIAL IDENTITIES (OPTIONAL)

Choose one ethnicity: Choose one or more (regardless of ethnicity):

 Hispanic/Latino

 Not Hispanic/Latino

 Asian  American Indian or Alaska Native  Black or African American  White  Native Hawaiian or other Pacific Islander

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Page 3 of 3 SY 2014-2015

DO NOT FILL OUT THIS PART. THIS IS FOR SCHOOL USE ONLY.

Annual Income Conversion: Weekly x 52, Every 2 Weeks x 26, Twice A Month x 24 Monthly x 12

Total Income: ____________ Per:  Week,  Every 2 Weeks,  Twice A Month,  Month,  Year Household size: ________

Categorical Eligibility: ______ Eligibility: Free______ Reduced______ Denied______ Date Withdrawn:______________

Reason for denial or withdrawal: ______________________________________________________________________________

Determining Official’s Signature: ________________________________________________ Date: _________________________

Confirming Official’s Signature: ________________________________________________ Date: _________________________

Verifying Official’s Signature: __________________________________________________ Date: _________________________

Your children may qualify for free or reduced price meals if your household income falls at or below the limits on this chart.

The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the last four digits of the social security number of the adult household member who signs the application. The last four digits of the social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules.

The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at

http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202)690-7442 or email at [email protected].

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish).

USDA is an equal opportunity provider and employer.

SHARING INFORMATION WITH MEDICAID/SOONER CARE

Dear Parent/Guardian:

If your children get free or reduced price school meals, they may also be able to get free or low-cost health insurance through Medicaid or Sooner Care.

Children with health insurance are more likely to get regular health care and are less likely to miss school because of sickness.

Because health insurance is so important to children’s well-being, the law allows us to tell Medicaid and Sooner Care that your children are eligible for free or reduced price meals, unless you tell us not to. Medicaid and Sooner Care only use the information to identify children who may be eligible for their programs. Program officials may contact you to offer to enroll your children. Filling out the Free and Reduced Price School Meals Application does not automatically enroll your children in health insurance.

If you do not want us to share your information with Medicaid or Sooner Care, fill out the form below and send in (Sending in this form will not change whether your children get free or reduced price meals).



No! I DO NOT want information from my Free and Reduced Price School Meals Application shared with Medicaid or Sooner Care.

If you checked no, fill out the form below to ensure that your information is NOT shared for the child(ren) listed below:

Child's Name: ___________________________________________School: _________________________________________

Signature of Parent/Guardian: ________________________________________________________Date: _______________

Printed Name: __________________________________________________________________________________________

Address: _______________________________________________________________________________________________

For more information, you may call your child’s school. Return this form to your child’s school.

FEDERAL ELIGIBILITY INCOME CHART For School Year 2014-2015

Household size Yearly Monthly Twice per Month Every two Weeks Weekly

1 21,590 1,800 900 831 416

2 29,101 2,426 1213 1120 560

3 36,612 3,015 1526 1409 705

4 44,123 3,677 1839 1698 849

5 51,634 4,303 2152 1986 993

6 59,145 4,929 2465 2275 1,138

7 66,656 5,555 2778 2564 1,282

8 74,167 6,181 3091 2853 1,427

Each additional person:

7,511 626 313 289 145

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